CORONAVIRUS (COVID-19)
(updated 05/16/2021)
​Please go to the end of this page for information regarding COVID-19 vaccine and check back as needed for updates

If you are sick, please stay home. 

We require all staff, patients and visitors to wear a mask that covers the mouth and nose. Masks with valves are NOT allowed since they do not prevent the transmission of virus.

We request that for your appointment, you come alone unless assistance is required for translation, you are unable to manage walking by yourself, or have issues with your memory/comprehension.  This precaution is to limit exposure to the visitors, other patients and staff.  If a driver is necessary, we request that they wait outside or in the waiting room.  We hope you understand that we are trying to limit the spread of COVID-19 in any way possible. 
 
Our current guidelines are to continue all the medications prescribed to you by our office including prednisone, biologic therapy, and all DMARD therapy.  However, if you have been exposed to someone who has tested positive for COVID-19 or is undergoing testing for COVID-19, hold biologic therapy/targeted DMARD therapy for 2 weeks (except you may continue Actemra and Kevzara). If you remain symptom free (with no fevers, chills, cough, or shortness or breath), you may resume your biologic therapy. 

​If you have any signs/symptoms of coronavirus such as fever, cough, shortness of breath, loss of smell/taste, we ask that you call your family doctor’s office for guidance regarding testing and treatment for coronavirus.  Continue your Hydroxychloroquine/Chloroquine.  Stop Methotrexate, Leflunomide, Azathioprine, Sulfasalazine.  If you are on steroids (prednisone, methylprednisolone), please call our office for directions.  Steroids should never be stopped abruptly.  Stop targeted DMARD/biologic therapy (Remicade, Humira, Enbrel, Simponi, Cimzia, Orencia, Xeljanz, Olumiant, Rinvoq, Rituxan, Benlysta) just as you would hold these medications for any other illness.  However, if you are on Actemra or Kevzara, please call our office for further directions regarding their continued use.
 
If you have a fever, avoid taking lNSAIDs (Ibuprofen, Aleve meloxicam etc).  You may take Tylenol for a fever.  If you already take an NSAID regularly, you may continue to take it as long as you do not have severe respiratory symptoms. 

We understand that with a new disease like COVID-19, recommendations change with time based on new information that is collected.
The current recommendations from the American College of Rheumatology released in 05/2020 report that the "risk of poor outcomes from COVID-19 appear to be related primarily to general risk factors such as age and co-morbidities" (diabetes, heart disease, lung disease, obesity) rather than rheumatic diseases or the use of immunosuppressive therapy.  However, there is a higher risk of hospitalization in rheumatology patients taking prednisone 10mg/day or higher but not with the use of NSAIDs, DMARDs, biologic drugs, JAK inhibitors.
The primary focus is still to avoid getting COVID-19 with practicing social distancing, frequent hand washing.

Based on this information, we are unable to provide a letter specific to your disease or treatment but recommend you discuss it with your employer regarding ways to maintain social distancing per CDC guidelines.

You may return to work or come to the clinic (based on guidelines from the American College of Rheumatology published on 7/13/2020) or resume your medications prescribed by our office (no clear evidence on this yet):

If you have tested positive for COVID-19 and were symptomatic:
- you have been fever free (temperature less than 99 degrees) for at least 72 hours without the use of acetaminophen (Tylenol) or other fever reducing medications (low dose aspirin 81mg/day is OK) 
- have no respiratory symptoms
- AND at least 10 days have passed since the onset of symptoms OR 2 consecutive negative tests by PCR done at least 24 hours apart (you will need the negative tests if you take Tylenol products regularly for pain control and are unable to stop or 72 hours)
- AND at least 20 days have passed since the onset of symptoms IF you are on prednisone 20mg or higher dose/day for more than 2 weeks in the last month OR had a severe/critical illness
- OR at least 3 weeks has passed since the onset of symptoms and you have been asymptomatic for 3 days.

If you have tested positive for COVID-19 and were asymptomatic:
- it is has been at least 10 days since contact with a known positive OR 2 consecutive negative tests by PCR done at least 24 hours apart

If you have had contact with a known positive COVID-19 patient, your test for COVID-19 has to be done at least 5-7 days AFTER the contact. Any test prior to that may be falsely negative. You should self isolate (quarantine) until testing results are known or for 10 days (if unable to get tested). If negative, it is unlikely that you have COVID-19 but if you have symptoms, you must assume you are positive (even if the test is negative) and follow the guidelines for a positive test.

All the currently available vaccines in the US - Pfizer/BioNTech, Moderna and Johnson and Johnson (received emergency use authorization by the FDA) are not live vaccines.  However, the vaccine studies so far have not included subjects who are immunocompromised or have autoimmune disease.  
The American College of Rheumatology released guidelines (not rules) for the COVID-19 vaccine in patients with rheumatic illness:

EVERYONE SHOULD GET THE VACCINE (DOESN'T MATTER WHICH ONE)
  • No modifications to either immunomodulatory therapy or vaccination timing
    • Hydroxychloroquine (Plaquenil); IVIG; glucocorticoids (steroids), prednisone <20mg/day
    • Sulfasalazine; Leflunomide (Arava); Azathioprine (Imuran); oral Cyclophosphamide (Cytoxan);
    • TNFi (Enbrel, Humira, Remicade, Simponi, Cimzia); IL-6R (Actemra, Kevzara); IL-1 (Anakinra, Kineret); IL-17 (Cosentyx, Taltz); IL-12/23 (Stelara); IL-23 (Tremfya); Belimumab (Benlysta); oral calcineurin inhibitors (cyclosporin, Voclosporin)
  • HOLD Therapy (only if your disease is well controlled - you have not used higher dose prednisone for at least one month; please check with your rheumatologist if you are uncertain about your disease control) 
    • Methotrexate (MTX): Hold MTX one dose after each vaccine dose or on the day of the vaccine if your MTX happens to be on the same day as the vaccine; if you receive a single dose vaccine, hold MTX for 2 doses after the vaccine
    • Cellcept (mycophenolate): Hold for one week after each dose of vaccine
    • JAK Inhibitor (Xeljanz, Rinvoq, Olumiant): Hold JAKi for 1 week after each vaccine dose
    • Abatacept (Orencia): Hold SQ abatacept both one week prior to and one week after the first COVID-19 vaccine dose (only); no interruption around the second vaccine dose
      • IV ABA (Orencia): Time vaccine administration so that the first vaccination will occur four weeks after abatacept infusion (i.e., the entire dosing interval), and postpone the subsequent abatacept infusion by one week (i.e., a 5-week gap in total); no medication adjustment for the second vaccine dose
    • Rituximab (Rituxan): Schedule vaccination so that the vaccine series is initiated approximately 4 weeks prior to next scheduled rituximab cycle; after vaccination, delay Rituxan 2-4 weeks after 2nd vaccine dose, if disease activity allows
    • IV Cyclophosphamide (Cytoxan, CYC): Time CYC infusion one week after each vaccine dose, when feasible



Here is a link to more information about vaccines against COVID-19:

https://www.arthritis.org/health-wellness/about-arthritis/related-conditions/other-diseases/covid-19-faqs-medication-treatment-and-vaccines

https://www.nejm.org/covid-vaccine/faq

To register for the vaccine, please check with your county public health department or your primary care physician's office. 
Many local pharmacies (Walgreens, CVS, HyVee) are also offering appointments for the vaccine. 

​https://immunize.scottcountyiowa.gov/

https://www.signupgenius.com/go/10c0f44acaa2fa57-covid191 (for Rock Island County)
​​

We ask that you follow the guidelines suggested by CDC and please review the following website for additional up to date information.
www.coronavirus.gov​